Spinal epidural haematoma misdiagnosed as meningitis

A 32-year-old man developed sudden onset neck pain while at work. There was no headache, fever and no history of head or neck injury. He had been in good health. He continued to work and went home after seeing his doctor, who diagnosed muscle strain. Four days later the pain persisted and he was admitted to hospital. Examination revealed marked neck stiffness, generalized hyperreflexia but with preserved power and a fever of 38°C. Urgent computed tomography of the brain was normal. The blood white cell count was normal. CSF analysis revealed red blood cells and some white blood cells, a blood-stained high protein count of 7 g/litre and a low glucose of 0.7 mmol/litre. Simultaneous blood sugar concentration was 6.7 mmol/litre.